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General NPI Number Information
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NPI Number | 1871795559
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Entity Type | Individual
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Provider Name | MARY BETH LOPEZ PSY.D
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 6331 SW 41ST CT
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City | DAVIE
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State | FL
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Zip | 33314-3405
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Country | US
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Telephone | 954-533-9019
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Fax | 954-530-2054
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Provider Business Mailing Address
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Address Line | 3092 NW 127TH TER
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City | SUNRISE
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State | FL
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Zip | 33323-6343
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Country | US
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Telephone | 954-533-9019
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Fax | 954-530-2054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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Taxonomy #3
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 7941
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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Taxonomy #6
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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Taxonomy #7
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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